CUTANEOUS MYCOBACTERIAL DISEASES OF THE SKIN AND SOFT TISSUES (C FRANCO-PAREDES,
Mycobacterium abscessus Complex Cutaneous Infection
Eduardo H. Gotuzzo
Springer International Publishing AG, part of Springer Nature 2018
Purpose of Review The worldwide increase in skin infections due to Mycobacterium abscessus, especially in Latin America, and
its difficult diagnosis and treatment, makes a review of literature crucial in reminding and updating physicians about its presen-
tation, diagnosing techniques, and management.
Recent Findings Outbreaks are associated with cosmetic surgeries and medical tourism, but any kind of skin lesion can become
infected presenting as negative typical cultures and unsuccessful empirical treatments; therefore, a high clinical suspicion is
required. Molecular techniques are promising new diagnosing alternatives and treatment should be guided by susceptibility tests.
Summary Mycobacterium abscessus complex skin infections are concerning due to difficult diagnosis, burdensome treatment,
drug resistance, and high cost of management. Usually associated to cosmetic procedures, especially medical tourism, it can also
be related to other incisions (C-section, injections, laparoscopy, etc.). Diagnosis requires clinical suspicion and consists of
phenotypic and molecular methods to recognize the organisms to a subspecies level. Drug treatment frequently involves surgical
debridement and antibiotics with special concern about resistance and adverse events.
Keywords Nontuberculous mycobacteria
Skin infections due to nontuberculous mycobacteria (NTM)
are increasing worldwide, especially rapidly growing NTM
(RG-NTM) which can grow within 7 days. Mycobacterium
abscessus (M. abscessus) is clinically relevant as one of the
most frequent RG-NTM to cause skin infection in some stud-
ies in the USA and Taiwan [1•, 2] and also because it is the
most virulent and therapy-resistant rapidly growing NTM
strain . Its incidence has increased in UK from 1/100000
in 2000 to 60/100000 in 2006 , and skin and soft tissue
infections were the second most frequent manifestation of
M. abscessus infection in a French hospital .
M. abscessus complex is comprised of subspecies which
classification has been debated, but recently accepted as three
subspecies, consisting of M. abscessus subspecies abscessus
(M. abscessus), M. abscessus subspecies massiliense (M.
massiliense), and M. abscessus subspecies bolletii (M.
bolletii). Bacterial differentiation plays an important role
in disease treatment, as inducible resistance genes are fre-
quently found in M. abscessus and M. bolletii .
The most common mechanism of infection is usually asso-
ciated to open wound contamination with an infected source,
such as water, or an infected surgical or traumatic mechanism,
but high clinical suspicion is needed as negative cultures for
typical organisms and lack of response to empirical treatment
make the diagnosis a real challenge .
A literature review was made in PubMed and SciELO using
the following search terms: Mycobacterium abscessus,
Mycobacterium massiliense, Mycobacterium bolletii, cutane-
ous infection; and the MeSH terms “mycobacterium
“bolletii,”“skin,” and “cutaneous” in diverse combinations.
This article is part of the Topical Collection on Cutaneous Mycobacterial
Diseases of the Skin and Soft Tissues
* Eduardo H. Gotuzzo
Universidad Peruana Cayetano Heredia, Lima, Peru
Current Tropical Medicine Reports